Robotic interventional systems and devices are well suited for performing minimally invasive medical procedures as opposed to conventional techniques wherein the patient's body cavity is open to permit the surgeon's hands access to internal organs. Advances in technology have led to significant changes in the field of medical surgery such that less invasive surgical procedures, in particular, minimally invasive surgery (MIS), are increasingly popular.
MIS is generally defined as surgery that is performed by entering the body through the skin, a body cavity, or an anatomical opening utilizing small incisions rather than large, open incisions in the body. With MIS, it is possible to achieve less operative trauma for the patient, reduced hospitalization time, less pain and scarring, reduced incidence of complications related to surgical trauma, lower costs, and a speedier recovery.
MIS devices and techniques have advanced to the point where an elongated catheter instrument is controllable by selectively operating tensioning control elements within the catheter instrument. In one example, a remote catheter manipulator (RCM) or robotic instrument driver utilizes four opposing directional control elements which extend to the distal end of the catheter. When selectively placed in and out of tension, the opposing directional control elements may cause the distal end to steerably maneuver within the patient. Control motors are coupled to each of the directional control elements so that they may be individually controlled and the steering effectuated via the operation of the motors in unison.
At least two types of catheters may be employed for surgical procedures. One type includes an electrophysiology (EP) catheter that only requires a navigating distance of 15 cm or less. EP catheters also may be relatively thick and stiff and thus, due their short navigating length and high stiffness, EP catheters typically do not suffer from a tendency to buckle during use.
In comparison to EP procedures, vascular procedures include a greater amount of catheter insertion length, a greater number of catheter articulation degrees of freedom (DOFs), and a mechanism for manipulation of a guide wire. For that reason, known bedside systems provides mounting for splayer actuation hardware configured to provide the catheter insertion lengths, mounting which accounts for an increase in splayer size due to added DOFs, and mounting for a guide wire manipulator. Thus, vascular catheters typically include a relatively long stroke, such as one meter or more. Relative to EP catheters, vascular catheters are typically smaller, thinner and more flexible, and therefore have a greater tendency to buckle than EP catheters. As such, it is typically desirable to feed vascular catheters into the patient with minimal bending to reduce the tendency to buckle. Known vascular robotic catheter systems are therefore typically suspended over the patient that is lying prone on a bed.
A vascular catheter (elongate member) catheter system typically includes elongate members that include an outer catheter (sheath), an inner catheter (leader), and a guidewire. Each is separately controllable and therefore they can telescope with respect to one another. For instance, a sheath carriage controls operation of the sheath and is moveable about a generally axial motion along the patient, and a leader carriage controls operation of the guidewire and is likewise moveable about the generally axial direction of the patient. Typically, the leader carriage and the sheath carriage are positioned on a remote catheter manipulator (RCM), which is supported by a setup joint (SUJ). Because the sheath carriage and leader carriage are traditionally aligned along the insertion axis, this configuration results in the RCM taking up significant space and the RCM being restricted to a specific orientation and alignment based on the insertion location. The SUJ is typically positioned on a rail that is itself mounted to the bed, below which the patient is positioned.
The RCM typically carries the weight of both carriages as well as the other hardware that are used to operate the system. And, to provide a full stroke, the SUJ is passed through the full range of motion which, as stated, can exceed one meter. To do so, typically the SUJ is moved or rotated with respect to the rail and the rail is stationary. For this reason, a bedside system is typically included that provides mounting for splayer actuation hardware configured to provide catheter insertion lengths, and mounting for a guide wire manipulator. Because this hardware is supported by the SUJ, the system can not only be cumbersome to work with, but it can interfere with other system operation (such as the C-arm and monitors), as well as provide significant weight that is carried by the bed.
However, in some clinical situations, it is difficult, if not impossible to orient the RCM such that it is aligned along the insertion axis. For instance, in some MIS procedures an imaging device may be required in addition to the RCM. In order for the imaging device to scan the entire body, the RCM should be oriented so that it is not obstructing the imaging devices ability to capture the entire body. For example, if the insertion location is at the patient's thigh and catheter is directed towards the patient's heart, the current RCM configuration would require the RCM to be located at the base of the patient's bed below their feet. The likelihood of the catheter buckling between the RCM and the insertion location also increases as the distance between the RCM and the insertion location increases and often requires more than one person to assist in operation of the RCM, especially during tool exchanges.
As such, there is a need for an improved catheter system that can handle functional challenges experienced with long catheters and provides greater flexibility with regard to the orientation of the RCM with regard to the insertion axis. There is also a need to for an improved catheter system that operates over a smaller footprint and weighs less.